Covid story 16

Lisa Leppard, Family Liaison Sister, Princess Anne Neonatal Unit, Southampton, UK

Reflect. I needed to step off the Merry go round. I needed to breathe. I felt like I’d been holding my breath for 12 weeks. Locking down my ability to breath and think freely. I walked into intensive care to see another little baby moving towards end of life. I just couldn’t do it. I couldn’t face the parents. I had nothing left to give. I turned and walked away. Was I brave or broken? Covid…… None of us know how we will truly emerge from this as people. Nurses. Mothers. Friends. Family. I know it has changed me. I’m not entirely sure how I will emerge, but I’m determined that this negative monster will not tame me. I will process, reflect and incorporate it into me, not let “it” define who I am. In this time of lack of control and enforced change I will take back the reins and find my way through this. My ways of working with and supporting families through their neonatal journey can only be stronger, more informed and the value of hugs will be priceless.

COVID-19 and the impact of temporary Neonatal Unit Closure

Heather Murphy, Northern Ireland

COVID-19 has presented many challenges nationally and resulted in the formation of the Paediatric surge plan within Northern Ireland to ensure the safety and security of both neonatal and paediatric services during a worldwide pandemic. To preserve these services a five step plan was created by the Department of Health, step one of this plan was initiated via the temporary closure of three paediatric inpatient wards, reallocation of intrapartum care in one hospital and the closure of one Neonatal Unit.

The temporary closure allowed local evaluation of the impact on maternity and paediatric services and considered the predicted increased demand in these services alongside the unknown timescale of service disruption, consequently the Neonatal nurse support role was developed. The role involved approximately half of the permanent Neonatal nursing team remaining on site to work collaboratively with maternity and paediatric services, to provide support for midwifery staff to reduce the incidence of infants requiring Neonatal Unit level care, stabilisation and subsequent transfer of infants requiring Neonatal Unit admission. To facilitate this service need throughout the paediatric surge plans, the creation of this role alongside collaborative working, medical and nursing education and staff support were paramount to ensure the safe and effective care of patients requiring stabilisation for ongoing neonatal care who are both non COVID-19 & suspected/ confirmed COVID-19.

The remaining nursing team were redeployed to the hospitals sister Neonatal Unit located one hour and twenty minutes from the temporarily closed unit. Challenges were presented through additional travel time combined with a shift work rota and orientation to a new Neonatal Unit, however redeployment offered the opportunity to work at a busy Neonatal Unit, care for infants requiring a higher care level than commissioned within their home unit and offered additional experience in another Neonatal Unit. Furthermore collaboration with the sister unit can assist cross sector working within the hospital trust, opportunity to undertake additional competencies which are infrequently undertaken in the home unit and temporarily work within a new multidisciplinary team.

Post paediatric surge plans have involved planned reopening of the closed Neonatal Unit which prior to reopening offered the opportunity for ward based reorganisation which would otherwise be highly difficult during normal service, whilst also acknowledging the impact of change projects following the surge plans. Additionally ensuring staff engagement to provide support and evaluate the Neonatal nurse support role following reopening of services.

COVID-19 has directly impacted neonatal nursing staff work life on both hospital sites alongside disruption in staff personal life due the pandemic. Despite the ongoing pressures within neonatal nursing combined with the impact of the paediatric surge plans have highlighted staff resilience throughout an unprecedented time within our speciality. The surge plans have allowed us to continue to provide safe and sustainable care for infants within the Northern Ireland Neonatal Network and collaboratively work with our maternity and paediatric colleagues to provide high quality care.

Following the reopening of the Neonatal Unit there is now focus on maintaining collaborative working within the home unit site, reflection of the continued positive working relationship with the sister Neonatal Unit and supporting staff following the impact of the paediatric surge plans but also remaining aware COVID-19 is ongoing and preparing for a potential second wave and further impact on our infants, families and staff.

Rachel Grech, Senior staff Nurse & Infection Control Link Nurse – Mater Dei Hospital – Malta

As a Senior Staff Nurse and Infection Control Link Nurse working in the NPICU, the Covid-19 Pandemic brought about various challenges. My first thoughts were how this virus was going to affect our vulnerable patients and how we could best protect them, therefore I set about reading up on as much available literature as I could find and communicated online with nurses from other countries with regards to neonates and Paediatrics. The general consensus was that neonates were rarely affected by covid-19 so this served to allay some fears, however I was still extremely anxious. Our staff canteen and lecture rooms were transformed into wards and all available spaces and corridors now housed hospital beds and mattresses, creating an unnerving atmosphere. Infection control took on unprecedented importance and I found myself to be the reference point for the nurses & midwives in all things Covid, using all available communication means to address queries.

My colleagues with previous ITU experience were prepared for the eventuality of having to float to adult ITU. I held mixed emotions, as on one hand I was quite fearful of being in such a situation but on the other hand I felt quite guilty for not being able to help out fellow nurses in other critical units. Another nagging fear was of bringing something home after my shifts other than my uniform. Several of my colleagues found alternative accommodation and we all had a plan B in mind just in case we needed to be quarantined. Initially we had several nurses in quarantine due to recent travel and others who remained quarantined throughout due to being classed as ‘high risk’, so we all had to adapt and work extra shifts accordingly. I was concerned that in the eventuality of an outbreak there might not be enough staff to care for our patients, since our unit is the only one on the island and our relieving pool is extremely sparse.

Initially I was present for meetings with the infection Control and Neonatal teams to discuss various admission strategies, which involved creating pathways from the delivery suite, theatres, A & E and other Paediatric wards. I also helped with the creation/updating of various protocols with regards to parental presence on the unit, the handling of expressed breast milk, and the disinfection & disposal of contaminated items.  It was extremely confusing as pathways kept changing making it next to impossible to keep track of the correct ones.

I was part of a coalition group to carry out certain modifications within the unit. Isolation rooms were stripped down to a bare minimum, item cupboards removed, panelled doors exchanged for glass doors to ensure visibility, appropriate signage was affixed, a communication system was installed and mirrors were fitted to aid with the correct donning of PPE. Centrally located cupboards were installed for all the necessary PPE and various quick access trolleys for difficult airway management were set up. We also assembled packs of collated items to take down to the various ‘Covid theatres’ for caesarian deliveries and a variety of procedure packs. I had to prepare for the eventuality of admitting older paediatric patients which involved procuring unfamiliar equipment and drugs. I even made a trip to the home improvement store to purchase transparent plastic sheeting to prevent aerosolization of viral particles during intubation.

I helped provide simulation training for proning techniques in paediatric ventilated patients and was also tasked with training all the department staff to safely don and doff the necessary PPE. This was not without its difficulties, as simultaneously the nursing & midwifery union was arguing that the PPE we had access to was not adequate, creating a lot of anxiety and mistrust amongst colleagues. This was further compounded by tight restrictions on FFP3 masks. Unfortunately we also had an initial shortage of alcohol based hand rub and wipes with these items being kept under lock and key in the manager’s office; needless to say hand hygiene compliance dropped and I was very worried about the ensuing consequences.

Now that our islands have succeeded in ‘flattening the curve’, I am finally getting used to the new normality of working with a mask and visor throughout my 12-hour shifts. I fear that our patients and parents continue to suffer inadvertently due to the tight restrictions on parent visiting and handling and am currently advocating for this policy to be re-evaluated.

Covid story 18

COVID-19 and the impact of temporary Neonatal Unit Closure

Heather Murphy, Northern Ireland

COVID-19 has presented many challenges nationally and resulted in the formation of the Paediatric surge plan within Northern Ireland to ensure the safety and security of both neonatal and paediatric services during a worldwide pandemic. To preserve these services a five step plan was created by the Department of Health, step one of this plan was initiated via the temporary closure of three paediatric inpatient wards, reallocation of intrapartum care in one hospital and the closure of one Neonatal Unit.

The temporary closure allowed local evaluation of the impact on maternity and paediatric services and considered the predicted increased demand in these services alongside the unknown timescale of service disruption, consequently the Neonatal nurse support role was developed. The role involved approximately half of the permanent Neonatal nursing team remaining on site to work collaboratively with maternity and paediatric services, to provide support for midwifery staff to reduce the incidence of infants requiring Neonatal Unit level care, stabilisation and subsequent transfer of infants requiring Neonatal Unit admission. To facilitate this service need throughout the paediatric surge plans, the creation of this role alongside collaborative working, medical and nursing education and staff support were paramount to ensure the safe and effective care of patients requiring stabilisation for ongoing neonatal care who are both non COVID-19 & suspected/ confirmed COVID-19.

The remaining nursing team were redeployed to the hospitals sister Neonatal Unit located one hour and twenty minutes from the temporarily closed unit. Challenges were presented through additional travel time combined with a shift work rota and orientation to a new Neonatal Unit, however redeployment offered the opportunity to work at a busy Neonatal Unit, care for infants requiring a higher care level than commissioned within their home unit and offered additional experience in another Neonatal Unit. Furthermore collaboration with the sister unit can assist cross sector working within the hospital trust, opportunity to undertake additional competencies which are infrequently undertaken in the home unit and temporarily work within a new multidisciplinary team.

Post paediatric surge plans have involved planned reopening of the closed Neonatal Unit which prior to reopening offered the opportunity for ward based reorganisation which would otherwise be highly difficult during normal service, whilst also acknowledging the impact of change projects following the surge plans. Additionally ensuring staff engagement to provide support and evaluate the Neonatal nurse support role following reopening of services.

COVID-19 has directly impacted neonatal nursing staff work life on both hospital sites alongside disruption in staff personal life due the pandemic. Despite the ongoing pressures within neonatal nursing combined with the impact of the paediatric surge plans have highlighted staff resilience throughout an unprecedented time within our speciality. The surge plans have allowed us to continue to provide safe and sustainable care for infants within the Northern Ireland Neonatal Network and collaboratively work with our maternity and paediatric colleagues to provide high quality care.

Following the reopening of the Neonatal Unit there is now focus on maintaining collaborative working within the home unit site, reflection of the continued positive working relationship with the sister Neonatal Unit and supporting staff following the impact of the paediatric surge plans but also remaining aware COVID-19 is ongoing and preparing for a potential second wave and further impact on our infants, families and staff.

Rachel Grech, Senior staff Nurse & Infection Control Link Nurse – Mater Dei Hospital – Malta

As a Senior Staff Nurse and Infection Control Link Nurse working in the NPICU, the Covid-19 Pandemic brought about various challenges. My first thoughts were how this virus was going to affect our vulnerable patients and how we could best protect them, therefore I set about reading up on as much available literature as I could find and communicated online with nurses from other countries with regards to neonates and Paediatrics. The general consensus was that neonates were rarely affected by covid-19 so this served to allay some fears, however I was still extremely anxious. Our staff canteen and lecture rooms were transformed into wards and all available spaces and corridors now housed hospital beds and mattresses, creating an unnerving atmosphere. Infection control took on unprecedented importance and I found myself to be the reference point for the nurses & midwives in all things Covid, using all available communication means to address queries.

My colleagues with previous ITU experience were prepared for the eventuality of having to float to adult ITU. I held mixed emotions, as on one hand I was quite fearful of being in such a situation but on the other hand I felt quite guilty for not being able to help out fellow nurses in other critical units. Another nagging fear was of bringing something home after my shifts other than my uniform. Several of my colleagues found alternative accommodation and we all had a plan B in mind just in case we needed to be quarantined. Initially we had several nurses in quarantine due to recent travel and others who remained quarantined throughout due to being classed as ‘high risk’, so we all had to adapt and work extra shifts accordingly. I was concerned that in the eventuality of an outbreak there might not be enough staff to care for our patients, since our unit is the only one on the island and our relieving pool is extremely sparse.

Initially I was present for meetings with the infection Control and Neonatal teams to discuss various admission strategies, which involved creating pathways from the delivery suite, theatres, A & E and other Paediatric wards. I also helped with the creation/updating of various protocols with regards to parental presence on the unit, the handling of expressed breast milk, and the disinfection & disposal of contaminated items.  It was extremely confusing as pathways kept changing making it next to impossible to keep track of the correct ones.

I was part of a coalition group to carry out certain modifications within the unit. Isolation rooms were stripped down to a bare minimum, item cupboards removed, panelled doors exchanged for glass doors to ensure visibility, appropriate signage was affixed, a communication system was installed and mirrors were fitted to aid with the correct donning of PPE. Centrally located cupboards were installed for all the necessary PPE and various quick access trolleys for difficult airway management were set up. We also assembled packs of collated items to take down to the various ‘Covid theatres’ for caesarian deliveries and a variety of procedure packs. I had to prepare for the eventuality of admitting older paediatric patients which involved procuring unfamiliar equipment and drugs. I even made a trip to the home improvement store to purchase transparent plastic sheeting to prevent aerosolization of viral particles during intubation.

I helped provide simulation training for proning techniques in paediatric ventilated patients and was also tasked with training all the department staff to safely don and doff the necessary PPE. This was not without its difficulties, as simultaneously the nursing & midwifery union was arguing that the PPE we had access to was not adequate, creating a lot of anxiety and mistrust amongst colleagues. This was further compounded by tight restrictions on FFP3 masks. Unfortunately we also had an initial shortage of alcohol based hand rub and wipes with these items being kept under lock and key in the manager’s office; needless to say hand hygiene compliance dropped and I was very worried about the ensuing consequences.

Now that our islands have succeeded in ‘flattening the curve’, I am finally getting used to the new normality of working with a mask and visor throughout my 12-hour shifts. I fear that our patients and parents continue to suffer inadvertently due to the tight restrictions on parent visiting and handling and am currently advocating for this policy to be re-evaluated.

Covid story 17

A personal reflection of working in the NPICU throughout Covid-19

Rachel Grech, Senior staff Nurse & Infection Control Link Nurse – Mater Dei Hospital – Malta

As a Senior Staff Nurse and Infection Control Link Nurse working in the NPICU, the Covid-19 Pandemic brought about various challenges. My first thoughts were how this virus was going to affect our vulnerable patients and how we could best protect them, therefore I set about reading up on as much available literature as I could find and communicated online with nurses from other countries with regards to neonates and Paediatrics. The general consensus was that neonates were rarely affected by covid-19 so this served to allay some fears, however I was still extremely anxious. Our staff canteen and lecture rooms were transformed into wards and all available spaces and corridors now housed hospital beds and mattresses, creating an unnerving atmosphere. Infection control took on unprecedented importance and I found myself to be the reference point for the nurses & midwives in all things Covid, using all available communication means to address queries.

My colleagues with previous ITU experience were prepared for the eventuality of having to float to adult ITU. I held mixed emotions, as on one hand I was quite fearful of being in such a situation but on the other hand I felt quite guilty for not being able to help out fellow nurses in other critical units. Another nagging fear was of bringing something home after my shifts other than my uniform. Several of my colleagues found alternative accommodation and we all had a plan B in mind just in case we needed to be quarantined. Initially we had several nurses in quarantine due to recent travel and others who remained quarantined throughout due to being classed as ‘high risk’, so we all had to adapt and work extra shifts accordingly. I was concerned that in the eventuality of an outbreak there might not be enough staff to care for our patients, since our unit is the only one on the island and our relieving pool is extremely sparse.

Initially I was present for meetings with the infection Control and Neonatal teams to discuss various admission strategies, which involved creating pathways from the delivery suite, theatres, A & E and other Paediatric wards. I also helped with the creation/updating of various protocols with regards to parental presence on the unit, the handling of expressed breast milk, and the disinfection & disposal of contaminated items.  It was extremely confusing as pathways kept changing making it next to impossible to keep track of the correct ones.

I was part of a coalition group to carry out certain modifications within the unit. Isolation rooms were stripped down to a bare minimum, item cupboards removed, panelled doors exchanged for glass doors to ensure visibility, appropriate signage was affixed, a communication system was installed and mirrors were fitted to aid with the correct donning of PPE. Centrally located cupboards were installed for all the necessary PPE and various quick access trolleys for difficult airway management were set up. We also assembled packs of collated items to take down to the various ‘Covid theatres’ for caesarian deliveries and a variety of procedure packs. I had to prepare for the eventuality of admitting older paediatric patients which involved procuring unfamiliar equipment and drugs. I even made a trip to the home improvement store to purchase transparent plastic sheeting to prevent aerosolization of viral particles during intubation.

I helped provide simulation training for proning techniques in paediatric ventilated patients and was also tasked with training all the department staff to safely don and doff the necessary PPE. This was not without its difficulties, as simultaneously the nursing & midwifery union was arguing that the PPE we had access to was not adequate, creating a lot of anxiety and mistrust amongst colleagues. This was further compounded by tight restrictions on FFP3 masks. Unfortunately we also had an initial shortage of alcohol based hand rub and wipes with these items being kept under lock and key in the manager’s office; needless to say hand hygiene compliance dropped and I was very worried about the ensuing consequences.

Now that our islands have succeeded in ‘flattening the curve’, I am finally getting used to the new normality of working with a mask and visor throughout my 12-hour shifts. I fear that our patients and parents continue to suffer inadvertently due to the tight restrictions on parent visiting and handling and am currently advocating for this policy to be re-evaluated.

Covid story 15

COVID-19 and Nursing Education – Reflections from a Dean and Faculty Member

Andréia Cascaes Cruz

PhD, RN, Professor at the Escola Paulista de Enfermagem, Universidade Federal de São Paulo, Brazil; First Secretary of the Brazilian Society of Pediatric Nurses, COINN Board Member

Myriam Aparecida Mandetta

PhD, RN, Professor at the Escola Paulista de Enfermagem, Universidade Federal de São Paulo, Brazil; President of the Brazilian Society of Pediatric Nurses

At the time of writing, over 1.3 million COVID-19 cases, with roughly 57 000 deaths, have been confirmed in Brazil, according to WHO data. Nonetheless, COVID-19 has not had a major impact on babies’ health in the country, as few neonates have been affected and nearly all those testing positive have recovered. Brazil comprises a huge territory, with stark differences in neonatal care. Meanwhile, the COVID-19 pandemic has adversely affected parents and whole families likewise. The birth of a new family member has now acquired an unprecedented feature: parents are now alone—a dramatically changed family event.

Having a child admitted to a NICU (Neonatal Intensive Care Unit) is hard on families, which in times of COVID-19 has been made more difficult to bear. Families are now affected by mandatory separation, not only between parents and baby, but also between the two parents. In some NICUs, either the mother or the father (but never both) are allowed to stay with the child. This visiting time, moreover, is limited to three hours a day in some NICUs.

Before the pandemic, parents were free to remain with their children for unlimited time in Brazilian NICUs, while siblings and grandparents were granted visits once or twice a week—a family inclusion arrangement only recently adopted in the country, reflecting strides made following Family-Centered Care (FCC) implementation. As FCC advocates in Brazil, there are now concerns at the prospect of losing this hard-won achievement that has benefited not only babies and families, but also healthcare professionals.

The effects of the pandemic on working nurses have been considerable, and burnout has been the main manifestation. Severe staffing shortages, extra shifts, and fear of contamination have compounded the workload of nurses in NICUs. Another element is moral distress. Many nurses suffer with baby–parent separation and the attitudes of some mothers—nurses have reported incidences of mothers hiding their COVID-19 symptoms, while others, despite evident symptoms, have refused to be tested for fear that a positive result will isolate them from their babies for at least 15 days. Nurses are feeling lost amid this “unknown landscape.”

The COVID-19 pandemic has forced families and nurses to face an as-yet unmapped challenge, and there is an urgent need to devise ways of mitigating their distress.

Covid story 14

Denise Holmes

Senior Midwife at the Neonatal & Paediatric Intensive Care Unit, Mater Dei Hospital, Malta.

I am a senior midwife at NPICU.  As a front liner in the pandemic my experience bore a lot of mixed feelings.  In March, the news of other countries that were hit so badly together with fast-paced changes in policy and the physical environment in the hospital was extremely worrying.  I was telling myself that our system was learning from the countries that were hit so badly, on the other hand, the common pensive moods always ended with the same thought: the worse was yet to come. The fear was ever-present, heavy, reaffirmed with every shift.  I needed to protect the fragile neonates and care for their parents whilst being really careful because going home, two members of my family of four are considered vulnerable.  This was very concerning.

Then there was the first Covid-19 positive baby on our unit.  We knew there had to be the first but it was still a shock.  We started swabbing everyone and the measures were stepped up.  A few days after, another baby developed symptoms and tested positive.  I was one of those who made contact so after a few hours after going home I got the call to isolate myself.  We had discussed this eventuality at home but when it hit home, we were panic-stricken.  I left home to quarantine for a fortnight.  No byes, no kisses, no hugs.  Worried, isolated, afraid, unable to explain to my kids. A fortnight of quarantine was an awful experience.  We would video call multiple times a day only to make me feel miserable afterwards.  Luckily I tested negative for Covid-19 after quarantine and my family was tested positive for resilience.

I was back at work.  So many things changed in two weeks and the distancing and safety measures adopted made caring and compassion feels like they were being omitted.  The one hour per day visiting restriction for parents was a fair deal in our eyes but even then, the parents were not being allowed to touch their young.  I worried about what it felt like not being able to bond with your firstborn.  Were the babies feeling alone, isolated?  Possibly.  I felt sorry for both parents and neonates.  Bereaving parents had it worse.  After the visiting restrictions, if their beloved baby passed away, they could not enter the unit.  This was very distressing for everyone.

I also vividly remember talking to a couple who’s child needed treatment abroad.  Usually, I’d feel useful, sure of myself, in the know, able to guide them through.  Now I felt the total opposite.  I couldn’t answer questions since policies were changing rapidly, the airport was said to be closing down soon.  Will the baby still be transferred?  Will they be allowed to accompany him?  Will they be allowed back if the airport was shut down?    Covid-19 was new, an unknown enemy challenging us to the core.  With other ailments, we could read until we knew it all.  To date, there is still very little material to refer to intensive neonatal care.  The feeling of unpreparedness before every shift is still real.  The long shifts wearing full PPEs make life harder for everyone and the heavy cloud of uncertainty is always looming over me.  After months of this, I’m getting more used to it although I’m not comfortable about it.  The fear?  I think that will need a lot of time to fade into irrelevance.

Covid story 13

COVID-19 and Nursing Education – Reflections from a Dean and Faculty Member

Carole Kenner, The College of New Jersey, Marina Boykova, Holy Family University, USA

COVID-19 changed the normal rhythm of our teaching.  In the United States, our programs were halfway through our semester – only weeks away from graduation ceremonies and summer vacations.  Suddenly we evacuated our offices and classrooms.  Our students moved out of their dorms with no time for saying goodbye to friends.  As faculty, we were thrust into using technology and online platforms that seemed foreign to many faculty who only taught in a traditional face-to-face manner.  Our clinical partners ban students-in part for their patient safety and because personnel protective equipment was scant. 

We live and work in one of the hardest-hit areas of the US and were under ‘shelter in place’ orders from mid-March through June.  In the first few chaotic weeks, we gave our nursing school laboratory equipment and protective gear away to nearby hospitals.  We received requests almost daily for help at the frontlines.  Students from our nursing and public health schools/departments were deployed to work in state and local departments of health call centers to answer questions about testing, symptoms, and treatment.  Others delivered meals and did health assessments for those who could not leave their homes.  Reports from the frontlines poured in describing emergency rooms as war zones – without adequate equipment or personnel.  Students, faculty, and staff were scared as family members and friends tested positive and some died.  People were dying alone.  Nurses used using all available technology such as FaceTimeã so loved ones could be present and say goodbye. Emotions ran high.  COVID-19 support groups were started to ensure that frontline nurses could stay strong. 

The campuses remained eerily quiet.  Streets deserted.  Stores boarded.  The days of isolation grew.  Yet the work of teaching and learning continued.  Classrooms and clinical rotations became online, virtual meetings and simulations.  The number of virtual meetings increased as well as hours of work.  The use of Zoomã, Google Hangouts ã, and other conference meeting software became the norm.  Seven and eight hours a day of intense meetings or teaching sessions and meetings with students set the day’s schedule.  For those in administration, plans for keeping faculty, staff, and students safe as well working on teaching plans/reopening plans for the fall added to the workload.  Eighteen-hour days became the norm.  We have never been as exhausted in our lives!

Worries about the success of the students ensued.  First, the question was did they have access to the Internet or computers/tablets for classes?  If not how could we provide this technology?  Would this teaching modality prepare them for the real world of nursing if they had limited patient contact? Would they pass their licensure and certification exams? All questions we asked each other.  As an administrator (CK) I worried about the impact on our budget, as we are very dependent on tuition and dormitory revenue.  How many students would not be able to continue in the summer or fall due to their family’s or their loss of employment?  We have about a 13% unemployment rate at present.  Our states (New Jersey and Pennsylvania) incurred heavy debt due to the large numbers of COVID-19. 

Several lessons have been learned during these unprecedented times of the pandemic.  Out of adversity comes creativity. Our senior students graduated and few suffered academic setbacks. Most students have jobs but have difficulties starting as testing sites for national licensure and certification exams remain limited and the board of nursing in New Jersey is furloughed due to budget cuts.  However, emergency measures afforded them the opportunity to work as graduate nurses before receiving their licensure.  Faculty found the use of technology in some cases, enhanced learning even though online teaching was more intense than in a face-to-face environment, so the online teaching and learning activities were not so bad as we thought. Innovative ideas sprang from adversity with faculty sharing ideas and working with administrators to strengthen programs, maintain quality education, but institute cost-saving measures.  We are entering a new way of life – wearing masks, practising social distancing, contact tracing – but as nurses, we are also recognizing the tremendous contribution we make either at the frontline of care or education.  We are making a difference in the lives of the people we serve and the students we educate.

Covid story 12

A Reflection on Covid-19 from an Irish Neonatal Nurse Perspective

Colette Cunningham, Senior NICU Nurse, UHW, Waterford, Ireland

Covid-19 first hit the shores of the Republic of Ireland on the 29th February 2020, and within three weeks, it had spread to all 32 counties. By the 12th of March, the Government of Ireland had closed all schools, colleges and childcare facilities, and for the first time in the history of the Republic, St. Patrick’s Day festivities were called off. On the night of the 17th March, the Taoiseach Leo Varadkar, instead gave a nation’s address, and suddenly the severity of this global pandemic was plain to see. It’s potential for destruction to life as we knew it was all too apparent. Life as I knew it, as a neonatal nurse in a large “Level 2” NICU, meant the potential for catastrophe for the vulnerable ill term and preterm infants in my care.

In that first week after Covid-19 reached our country, and indeed our county, the management and infection control teams (ICT) in our regional hospital swung into action. The hospital was put on an “infectious disease” lock down, and only one parent of paediatric inpatients were allowed to stay with their child. No other visitors were allowed in any other area of the hospital, except in the Neonatal ICU/SCBU. In the early days of uncertainty, it was decided amongst our ICT and senior management, that the mother of each infant in the NICU could visit for one hour every day. This hour was to be decided in advance of the visit, so the 2 metre distancing could be respected amongst staff and parents. Too many visitors at once jeopardised the likelihood of this being a reality. Mothers were asked to wear aprons and masks and to wash their hands thoroughly before entering the unit. The handwashing was something they were all too familiar with, the masks in 25 to 27 degree Celsius heat, was not. Priority was given to breastfeeding mothers, and a mother and baby room was made available for those trying to establish breastfeeding on the road to discharge home. An isolation bay was quickly turned into a receiving area for those infants at high risk of being Covid-19 positive, or of those born to a positive mother. We were in good shape for all potential isolation needs, a luxury we knew that was not afforded to the larger tertiary centres or smaller “Level 1” facilities across our region.

It has been decided in recent weeks to encourage visiting of either mother or father for one hour every day in our NICU. Those infants of breastfeeding mothers may also have a paternal visit once a week. This visiting is always carefully planned so as to not overcrowd the unit and to minimise risk to other infants, parents and staff. The visiting policy will be reviewed on a regular basis and the input of our ICT, management and Government guidelines will always be taken into consideration. The possibility of virtual visiting is also being explored, and is something we hope to achieve in the very near future.

As professionals we are striving to be ready and fully equipped to deal with the consequences of Covid-19 positive infants, positive mothers, positive colleagues and positive family members. We have designated “grab and go” sets of PPE for potential emergency and unforeseen resuscitations on the labour ward, which may involve aerosol generating procedures. This minimises the time it takes us to don the PPE before we reach the infant on the labour ward. We have a Covid-19 folder of updates on our desktop which we read during our shift to keep ourselves updated. Any immediate or new procedures that have been recommended to us are handed over at the start of every shift, to allow us to be fully informed and follow a general consensus of practices within our NICU. It has also become routine practice in our unit to decontaminate the telephone, the desktop and the external intercom after each use. We also keep personal diaries of those we have worked with, been in close contact with during a prolonged procedure, and the bed numbers of the infants we have looked after. This makes the possibility of contact tracing more reliable, should the need arise. Parents are encouraged to place their mobile phones in clear plastic bags provided by us, to allow them to take pictures of their infants, but also to reduce the risk of potential transmission of a multitude of micro-organisms to their infant and the immediate surroundings.

As a nurse in a NICU, the uncertainty of the times is palpable. Foremost on my mind is the welfare and the protection of the infants, my colleagues and indeed my own family at home. My mind is a flurry of mantras…stay 2 metres away, don’t forget your mask, are you handwashing at every appropriate opportunity? As NICU nurses, the WHO moments of hand hygiene are ingrained into our everyday practice. The social distancing and care of infants and mothers with masks and gloves however, is not. Staying 2 metres away from vulnerable mothers without any reassurance of touch, was and still is, extremely alien to me. But even more difficult is the handling and nurturing and developmental care of ill term and preterm infants with gloved hands. The reassurance of positive touch is still there, but the warmth and love of a human hand is not. I prioritise the provision of positive touch and skin to skin care between mother and baby, wherever and whenever possible in my working day. This “visiting hour” is carefully planned, and with the infant’s permission and affirmative cues, I provide this basic nurturing and healing contact for infant and mother. Every effort by staff and parents is being given to try to diminish the possibility of the contraction of this devastating virus in our NICU. Although it is against our usual nurturing and encouragement of parental involvement, we hope and strive for this to be a short term solution to the potential spread of this virus. Our priority right now is to protect the vulnerable infants in our care, to the best of our ability, within our given resources. Reassurance is now given with exaggerated nods and thumbs up. Muffled conversation through masks is also maintained with smiling eyes…at least I hope my eyes are smiling.